The Growing Trend of No Primary Surgery in Colorectal Cancer

2021 ◽  
Author(s):  
Thomas Peponis ◽  
Caitlin Stafford ◽  
James Cusack ◽  
Christy Cauley ◽  
Robert Goldstone ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Surgery

scholarly journals Hypertension and chronic kidney disease is highly prevalent in elderly patients with colorectal cancer undergoing primary surgery

2019 ◽  
Vol 28 (10) ◽  
pp. 1425-1428 ◽  
Author(s):  
Leszek Kozlowski ◽  
Klaudia Kozlowska ◽  
Jolanta Malyszko
Keyword(s):  
Colorectal Cancer ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Primary Surgery

Sidedness and prognostic factors of peritoneal metastatic colorectal cancer: A single center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15050-e15050
Author(s):  
Aysegul Ilhan ◽  
Umut Demirci ◽  
Bulent Aksel ◽  
Ferit Aslan ◽  
Lutfi Dogan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Metastasis ◽  
Single Center Experience ◽  
First Line Therapy ◽  
Primary Surgery ◽  
Survival Difference ◽  
Significant Survival ◽  
Single Centre Experience ◽  
Significant Difference ◽  
Visceral Metastases

e15050 Background: Peritoneal metastasis in colorectal cancer (pCRC) is associated with poor prognosis. This study aimed to present a single centre experience for patients with pCRC. Methods: Between 2012 and 2016, 60 patients diagnosed with pCRC included in this study. Demographic and clinico-pathologic characterictics of patients were retrospectively analysed using patient medical records. Results: A total of 60 patients (31 female) were included and the median age was 61. Fifty-five patients (91%) had peritoneal metastases at the initial diagnosis, 37 patients (61%) had the left-sided colon cancer and 33 patients (55%) had the visceral metastases. Peritoneal metastasis was detected in 7 patients during the primary surgery. 30 patients (50%) received biologic therapy; 25 patients (41.6%) received anti-VEGF (bev) and 5 patients (8.3%) received anti-EGFR (cet/ pan) as the first line therapy. Seven (11%) patients underwent cytoreductive surgery and HIPEC. Median PFS of the analyzed patients was 10 months (SE: 2; 95% CI 6-13.9) and mOS was 20 months (SE: 4.2; 95% CI 11.7-28.7). The mPFS and mOS were 16.6 months (SE: 4.9; 95% CI 6.9-26.4) and 28 months (SE:7.1; 95% CI 13.8-42.1) in the group received surgery and HIPEC, respectively. No statistically significant survival difference was detected in terms of primary tumor localization, the presence of visceral metastasis (Table 1). Conclusions: In our study, the prognosis of pCRC patients was observed to be worse regardless of localization and the presence of accompanying visceral disease. A statistically significant difference was observed in the survival of the patients that received biologics. [Table: see text]

scholarly journals Contribution of “complete response to treatment” to survival in patients with unresectable metastatic colorectal cancer: A retrospective analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259622
Author(s):  
Gulcan Bulut ◽  
Merve Guner Oytun ◽  
Elvina Almuradova ◽  
Mustafa Harman ◽  
Ruchan Uslu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Bone Metastasis ◽  
Metastatic Colorectal Cancer ◽  
Systemic Treatment ◽  
Complete Response ◽  
Response To Treatment ◽  
Primary Surgery ◽  
Number Of Patients ◽  
Unresectable Metastatic Colorectal Cancer

Background The aim of the study is to reveal the contribution of complete response (CR) to treatment to overall survival (OS) in patients with unresectable metastatic colorectal cancer. In addition, to evaluate progression-free survival (PFS) in patients who attained CR to treatment and to examine the clinicopathologic features of the patient group with CR. Methods This article is a retrospective chart review. Patients diagnosed with metastatic colorectal cancer were divided into two groups. The systemic treatment was compared with the patients who received a full response according to the Response Evaluation Criteria in Solid Tumors (RECIST1.1) and those who did not attain CR (progression partial response and stable response) in terms of both PFS and OS data, and the effect of attaining CR to treatment on prognosis was evaluated. Results A total of 222 patients were included in the study. 202 of 222 patients could be evaluated in terms of complete response. All data from their files were tabulated and analyzed retrospectively. The mean age of diagnosis of the study group was 60.13 ± 12.52 years. The total number of patients who attained CR to treatment was 31 (15.3%); 171 (84.6%) patients did not attain CR. Patients who had a CR had longer median PFS times than patients who did not have a CR (15.2 vs. 7.4 months, P<0.001). Patients who had CR had longer median survival times than patients who did not have a CR (39.2 vs. 16.9 months, P<0.001). In subgroup patients who underwent primary surgery, the number of patients who attained CR was statistically higher compared with the number of patients who did not attain CR (p<0.001). Complete response was less common in the presence of liver metastasis and bone metastasis (p = 0.041 and p = 0.046, respectively), had a negative prognostic effect. In other words, 89.1% of patients with liver metastasis, 100.0% of patients with bone metastasis, and 88.7% of those who died did not have a CR to the treatment. According to multivariate analysis, CR to treatment, primary surgery, first-line chemotherapy (combination compared with fluoropyrimidine), and no bone metastasis were found to be predictors for OS. Conclusion Providing CR with systemic treatment in patients with unresectable metastatic colorectal cancer (mCRC) contributes to prognosis. The primary resection in our secondary acquisitions from the study, the number of metastatic regions and the combination therapy regimens also contributed to the prognosis.

scholarly journals Circulating Vascular Endothelial Growth Factor Six Months after Primary Surgery as a Prognostic Marker in Patients with Colorectal Cancer

2003 ◽  
Vol 42 (8) ◽  
pp. 837-845 ◽  
Author(s):  
Kim Werther ◽  
Sten Sørensen ◽  
Ib J. Christensen ◽  
Hans J. Nielsen ◽  
Keyword(s):  
Colorectal Cancer ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Prognostic Marker ◽  
Vascular Endothelial ◽  
Primary Surgery ◽  
Endothelial Growth Factor

Predictors of primary and distant site surgery in patients with stage IV colorectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 499-499
Author(s):  
Lori Uyeno ◽  
Rebecca A. Nelson ◽  
Gagandeep Singh ◽  
Julio Garcia-Aguilar ◽  
Joseph Kim
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Low Socioeconomic Status ◽  
Primary Tumor ◽  
Stage Iv ◽  
Distant Disease ◽  
Distant Site ◽  
Stage Iv Colorectal Cancer ◽  
Primary Surgery ◽  
Colorectal Cancer Patients

499 Background: Operative management of primary tumor and distant metastases in stage IV colorectal cancer is highly variable and removal of asymptomatic primary tumors in the setting of distant disease remains controversial. The purpose of our study was to describe the patterns of surgery in stage IV colorectal cancer patients in a US population-based cohort and explore patient and tumor characteristics associated with treatment selection and survival. Methods: Stage IV colorectal cancer patients in Los Angeles County from 2000 to 2006 were identified using the LA County Cancer Surveillance Program registry. The cohort included 2,956 patients (2,211 stage IV colon and 745 stage IV rectal cancers). Cox proportional hazard models were used to estimate survival. Treatment was categorized as primary surgery, distant site surgery, or chemotherapy only. Multivariate logistic regression was used to identify patient and tumor variables associated with treatment. Results: Greater than 65% of the stage IV colorectal cohort had primary tumor surgery of which 51% had chemotherapy. Only 4.5% had surgery to remove distant disease. Patients who had chemotherapy only and no surgery was 15%. Median survival of primary surgery, distant surgery, or chemo only was 14, 21, and 11 months. Multivariate Cox regression revealed that primary surgery and distant surgery had a decreased risk of death compared to no surgery (HR= 0.4 p<.0001, HR=0.7 p<.004). Multivariate logistic regression was used to identify predictors associated with treatment selection. Patients >65 years (p<.003); low socioeconomic status (p<0.05); and rectal tumors (p<.0001) were less likely to have surgery of the primary tumor. Female gender (p<.0001) and primary tumor surgery (p<.0001) were predictors for distant site surgery whereas age>65 years (p<.0001) had a negative association. Conclusions: Our population-based study of stage IV colorectal cancer patients suggests that the majority of stage IV patients with distant disease have surgery, but less than 5% have surgery for distant disease. Although survival of stage IV colorectal patients is improved with surgery, increasing age, low socioeconomic status, and rectal tumors are negative predictors for undergoing surgery.

Trends in primary surgical resection and chemotherapy for metastatic colorectal cancer, 2000-2016.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16000-e16000
Author(s):  
Nina Niu Sanford ◽  
Michael Ryan Folkert ◽  
Todd Anthony Aguilera ◽  
Muhammad Shaalan Beg ◽  
Syed Mohammad Ali Kazmi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Metastatic Colorectal Cancer ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Cohort Analysis ◽  
Local Treatment ◽  
Primary Tumors ◽  
Primary Surgery ◽  
Multivariable Logistic Regression

e16000 Background: When, whether and in whom resection of the primary tumor for patients with metastatic colorectal cancer (CRC) is indicated remains incompletely elucidated, although a recent randomized trial (JCOG1007, presented at GI ASCO 2020) showed no survival benefit in resection of asymptomatic primary tumors in this population. Given the emergence of multiagent chemotherapy, surgery may be used less, but patterns of care for metastatic CRC have not been reported. As such, we sought to evaluate trends in use of primary surgical resection and chemotherapy among patients with metastatic CRC. Methods: Patients diagnosed with metastatic CRC between 2000-2016 were identified from the Surveillance, Epidemiology and End Results (SEER) registry. Multivariable logistic regression defined odds of undergoing primary surgical resection, with year of diagnosis as the primary independent variable. The cohort analysis was also stratified by primary site (colon versus rectum), age ( < 50 vs. >50 years) and whether patients also underwent resection of metastatic sites (yes versus no). The secondary endpoint of interest was receipt of any chemotherapy, also assessed by multivariable logistic regression. Results: Among 99,835 patients with metastatic CRC, 55,527 (55.7%) underwent resection of their primary tumor. The odds of undergoing primary surgery decreased with later year of diagnosis, with patients diagnosed in 2016 61.1% less likely to undergo surgery than those diagnosed in 2000 (AOR 0.39, 95% CI 0.36-0.42, p < 0.0001; absolute percent 62.3% to 43.8%). Black patients and women were also less likely to have surgery (p < 0.001). Similar trends by year for primary surgery were observed among each of the subgroups, although patients with colon primary, young adults (age < 50), and patients also undergoing metastatectomy were more likely to undergo primary surgery (p < 0.001 for all). In contrast, the odds of receiving chemotherapy increased dramatically with later year of diagnosis, with patients diagnosed in 2016 221% more likely to receive chemotherapy than those diagnosed in 2000 (AOR 2.21, 95% CI 2.04 to 2.40, p < 0.0001; 45.5% to 64.0%). Conclusions: From 2000-2016, we observed a sharp decline in the rate of primary surgical resection for patients with metastatic CRC, while use of chemotherapy increased over the same period. Prospective studies are needed to define the optimal local treatment for patients with metastatic CRC, perhaps with stratification by molecular and clinical characteristics, in order to optimize both cancer-specific and symptomatic outcomes.

scholarly journals Do we still need CRS and HIPEC in colorectal cancer in times of modern chemotherapy and immunotherapy?

2020 ◽  
Vol 13 (4) ◽  
pp. 430-433 ◽  
Author(s):  
Elisabeth Gasser ◽  
Pamela Kogler ◽  
Andreas Lorenz ◽  
Reinhold Kafka-Ritsch ◽  
Dietmar Öfner ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Poor Prognosis ◽  
Tumor Tissue ◽  
Residual Tumor ◽  
Short Review ◽  
Primary Surgery ◽  
Risk Patients ◽  
Crs And Hipec

SummaryPeritoneal carcinomatosis from colorectal cancer is associated with a poor prognosis and is usually treated with systemic chemotherapy and immunotherapy alone. In patients with isolated peritoneal carcinomatosis (PC) without nonperitoneal metastases, however, cytoreductive surgery (CRS) has been shown to significantly improve outcome and to achieve even cure in selected patients in combination with systemic therapy. The additional use of a hyperthermic intraperitoneal chemotherapy (HIPEC) is primarily indicated to control microscopical residual tumor tissue in the peritoneal cavity after successful CRS. Another more recent option is the application of an adjuvant HIPEC to prevent peritoneal carcinomatosis in high risk patients with pT4 cancer or perforated cancer at the time of or after primary surgery. The aim of this short review is to highlight the corresponding available literature and assess the role of CRS and HIPEC in the context of modern chemotherapy and immunotherapy.

scholarly journals Thumb metastases in a patient with colorectal cancer

2007 ◽  
Vol 15 (3-4) ◽  
pp. 97-98 ◽  
Author(s):  
Ivan Nikolic ◽  
Aleksandar Patrnogic ◽  
Bratislav Stojiljkovic ◽  
Bogdan Bogdanovic ◽  
Biljana Kukic
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Disease ◽  
Proximal Phalanx ◽  
Lumbar Vertebra ◽  
Palliative Radiotherapy ◽  
Metastatic Colorectal Carcinoma ◽  
Primary Surgery ◽  
History Of ◽  
Histopathologic Analysis ◽  
Hand Radiography

Bone metastases from colorectal cancer are not common and most frequently are manifesting in late history of metastatic disease. We present a 67-old man who had first symptoms of metastatic disease manifested with edema and decreased mobility of thumb of right hand. Radiography showed complete osteolysis of proximal phalanx of thumb, which appeared 30 months after primary surgery for colorectal cancer. Histopathologic analysis of amputated thumb confirmed diagnosis of metastatic colorectal carcinoma and excluded osteolysis of other reasons. Metastatic changes in the first and second lumbar vertebra, which were treated with palliative radiotherapy, were confirmed by additional diagnostics.

Comparison of long-term recurrence-free survival between primary surgery and endoscopic resection followed by secondary surgery in T1 colorectal cancer

2021 ◽  
Author(s):  
Eun Hye Oh ◽  
Nayoung Kim ◽  
Sung Wook Hwang ◽  
Sang Hyoung Park ◽  
Dong-Hoon Yang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Resection ◽  
Recurrence Free Survival ◽  
Secondary Surgery ◽  
Free Survival ◽  
Primary Surgery ◽  
T1 Colorectal Cancer

Mutations and Allelic Loss of p53 in Primary Tumor DNA From Potentially Cured Patients With Colorectal Carcinoma

2001 ◽  
Vol 19 (11) ◽  
pp. 2829-2836 ◽  
Author(s):  
Ann Forslund ◽  
Christina Lönnroth ◽  
Marianne Andersson ◽  
Hans Brevinge ◽  
Kent Lundholm
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Carcinoma ◽  
Metastatic Disease ◽  
Denaturing Gradient Gel Electrophoresis ◽  
P53 Gene ◽  
Allelic Loss ◽  
P53 Mutations ◽  
Conserved Regions ◽  
Primary Surgery ◽  
Significant Difference

PURPOSE: To compare p53 alterations in survivors and nonsurvivors after surgery for colorectal cancer. PATIENTS AND METHODS: Twenty-nine potentially cured patients with colorectal carcinoma, without recurrent disease for more than 6 years after their primary surgery, were selected to match a group of 41 colorectal cancer patients with early metastatic spread to the liver. All patients were screened for mutations in the p53 gene, exons 5 to 9, by denaturing gradient gel electrophoresis and subsequent sequencing. RESULTS: The frequency of p53 mutations was significantly different in cured patients (60%) compared with patients with early relapse (41%, P < .05). A significant difference was found in the distribution of mutations, indicating that potentially cured patients had a different proportion of mutations in conserved regions of p53 (P = .02). This difference was explained by a significantly different frequency of mutations in exon 8 (40% v 15%, P = .03), which is part of the conserved region V. All mutations in region V were codon 273 mutations in cured patients, whereas three of four mutations were located in codon 273 in patients with metastatic disease. Allelic loss of p53 (loss of heterozygosity [LOH]) was demonstrated in 26% of the cured patients and in 39% of patients with metastatic disease (P = .36). The combination of mutation and LOH of p53 was the same (17%) in both groups. CONCLUSION: A large number of p53 mutations in colorectal cancer do not promote disease progression. Some mutations, particularly within conserved regions, may even counteract negative functional effects of other p53 structural alterations. A complete loss of p53 function was not related to survival or progression after curative operation of colorectal carcinoma.

Sign in / Sign up

Export Citation Format

Share Document